In April 2017 UCL Vice-Provost International Dame Nicola Brewer gave a speech at the “Cardiology, Diabetes & Nephrology At the Limits” conference in South Africa, on “Are there limits to global engagement?”

This post is adapted from the speech Dame Nicola delivered.

At The Limits is organised by UCL’s Hatter Cardiovascular Institute in collaboration with the University of Cape Town, to set new standards in medical education for these closely linked disease areas.

By Dame Nicola Brewer (UCL Vice-Provost International)

I was delighted to attend the 19th annual ‘At The Limits’ conference. In addition to UCL’s longstanding association with the conference through Professor Derek Yellon (UCL Hatter Cardiovascular Institute), I had personal reasons for accepting his kind invitation: five years ago two South African heart specialists saved my husband’s life – he had an emergency quadruple bypass in the Vincent Pallotti clinic. Elwyn Lloyd spotted the problem and Suzanne Vosloo was the surgeon.  I’m not one of those people who think cardiologists are cold and clinical: the hug Suzanne gave me when we met in the Intensive Care Unit was almost as restorative as the bypass.

But clearly there is a prejudice about distant and superior surgeons. I Googled jokes about cardiologists and found one that struck me as relevant to what I was going to speak about – are there limits to global engagement? I refer mostly to diplomatic global engagement, from my time in the British Foreign Office, though I work now on academic global engagement for UCL.

“So, a famous heart surgeon goes in to a car repair workshop. A mechanic is fixing his car. The mechanic straightens up, wipes his hands on a rag and says, “I’ve opened her up, taken her valves out, put in new parts, and now she’ll drive like new. How come you get paid so much more than me for doing the same thing?” The surgeon replies, “Now try doing it with the engine running.”

Like surgeons, diplomats do it with the engine running. And there are limits to what you can do without stalling. If you’re a diplomat, it’s not your engine for a start – you’re not in the driving seat. The car belongs to, it is, another sovereign nation. So you need to be invited even to look under the bonnet. In fact, that’s the second step: you have to ‘receive agreement’ first – the host government has to agree to accept you as ambassador. Refusal is not unknown. Before you get agreement, you have to keep your posting a secret, out of courtesy to your future hosts – and a bit of superstition, like not counting chickens before they hatch.

When I became British High Commissioner in 2009 I learned rapidly just what a beautiful, complicated, self-critical and resilient country South Africa is. My first piece of confidential advice for the Foreign Secretary, I chose to present as Diagnosis and Prescription. I forget whether I included a Prognosis. But I was always being asked to predict what was going to happen next in South Africa.

The diagnosis first. Diplomats have to work out the underlying condition or conditions causing a multiple set of presenting conditions in foreign populations. What makes a country healthy, or sick; robust or vulnerable; wealthy or poor? It helps if the diplomat in question is also self-aware about the state of their own country. A little humility never hurts. As the scientist Isaac Newton said: “Tact is the knack of making a point without making an enemy.”

Prognosis in my world is about what’s likely to happen next economically or politically, when and with what impact. You draw historical or contemporary evidence from which you extrapolate. But every country is different, as is every patient. In my first overseas posting I predicted that the ruling party would lose power. I was right. Eight years later. If a doctor’s diagnosis proved correct after 8 years, I’m not sure that would be a great comfort to the patient. The experience taught me humility and patience.

So diagnosis and prognosis are relevant to the medical and the diplomatic professions. Both involve expertise and experience, and judgement – and there are human limits to all of those things. No-one gets it right all the time, and the important thing is to learn lessons from your failures.

But that’s where the comparison between doctors and diplomats probably breaks down. When I talked about ‘prescription’, I meant what the UK should do with South Africa, not to South Africa. I built my whole strategy for the four years I was there around what the UK and South Africa could do together. I guess progressive doctors these days take a shared approach to treatment decisions with their patients.

Ambassadors are like two-way interpreters: you’re explaining your own country to your host country. You’re explaining your host country to your own. And you’re trying to find shared understanding, common ground, between the two.

So, limits to diplomacy and global engagement? Yes and no. There are no limits, in the sense of the number of potential competing interests you have to understand, and the scope for trying to find common ground. And I’d say there’s no limit to how much engagement or diplomacy is worthwhile. The world will always need diplomats just like it will always need doctors.

But there are external constraints. Circumstances matter. I wouldn’t have chosen to arrive in South Africa at the beginning of a global economic crisis. Events in Libya and Syria didn’t make my job there easy. But other things did help. The 2010 World Cup and the 2012 London Olympics. Sports is ready made common ground: being the daughter of a former Welsh rugby international was more of a conversation opener than being the British High Commissioner.

Crises and tragedies can also have the effect of bringing countries closer rather than driving them apart – Marikana happened while I was in South Africa – in diplomacy as in medicine.

So my final word about limits to diplomacy and global engagement is something I learned in South Africa and have never forgotten. It’s an African proverb: “If you want to walk fast, walk alone. But if you want to walk far, walk together.”

The message is, get engaged with other people. Be globally engaged. That’s the way to go beyond the limits.